Oral Hairy Leukoplakia

Abstract

Oral hairy leukoplakia (OHL) and oral candidiasis (OC) are the most common Human Immunodeficiency Virus (HIV) infection-associated oral diseases, and can act as a marker for immunosuppression. Patients with a prolonged immunodeficiency caused by HIV infection tend to develop OHL and OC, as a progression of Acquired Immune Deficiency Syndrome (AIDS). Few studies describe the joint manifestation of OHL and OC, and its findings are enigmatic. Lower CD4 count and smoking in HIV-infected patients can be independent risk factors for joint manifestation of OHL and OC. OC can be a primary disease or a secondary lesion superimposed on OHL. OHL is a benign oral lesion related to the infection of oral epithelium by Epstein-Barr virus (EBV). It is commonly related with AIDS, but it may also be observed in patients with other immunosuppressed states. OHL is an asymptomatic white plaque on the lateral borders of the tongue and a flat, corrugated, or hairy surface that is not removable when scraped. EBV can be identified through electronic microscopy techniques, in situ hybridization, immunohistochemistry, and polymerase chain reaction; however, the exfoliative cytology can also be used to diagnose OHL. Treatment for OHL is not necessary in most of the patients. Topical treatment such as retinoid, podophyllin, podophyllin with penciclovir, podophyllin with acyclovir, acyclovir, and gentian violet is most commonly recommended for patients with OHL; but there are other options of treatment such as surgical excision, cryotherapy, and systemic therapy with antiviral drugs.